Ann Hepatobiliary Pancreat Surg.  2018 Aug;22(3):292-295. 10.14701/ahbps.2018.22.3.292.

Gallbladder agenesis: A case report and brief review

• Bianco G
• Frongillo
• Agnes S
• Nure E
• Silvestrini N

• KMID: 2420620
• DOI: http://doi.org/10.14701/ahbps.2018.22.3.292

Abstract

Agenesis of the gallbladder and cystic duct represents one of the rarest anomalies of the biliary system, with a reported incidence of 0.007% to 0.027%. Almost half of the patients develop common duct stones and 23% of them manifest signs and symptoms that mimic biliary colic. We present the case of a woman presenting with symptoms of biliary colic. Based on the clinical findings and after abdominal ultrasonography, which showed hyperechoic material in the gallbladder fossa, a laparoscopic cholecystectomy was planned. Laparoscopy failed to reveal either gallbladder or cystic duct. The procedure was continued to further search for ectopic sites of gallbladder. A condition of gallbladder agenesis was hypothesized and the procedure was aborted without dissection of hepatic pedicle or conversion to laparotomy. Agenesis of gallbladder and cystic duct was confirmed via pos-operative magnetic resonance cholangiopancreatography. We report our experience with regard to the challenges associated with the diagnosis and management, and a brief review of the literature of this rare pathology.

Keyword

Gallbladder agenesis; Laparoscopic cholecystectomy; Congenital abnormalities of the biliary tract

MeSH Terms

Biliary Tract
Cholangiopancreatography, Magnetic Resonance
Cholecystectomy, Laparoscopic
Colic
Cystic Duct
Diagnosis
Female
Gallbladder*
Humans
Incidence
Laparoscopy
Laparotomy
Pathology
Ultrasonography

Figure

• 

  Fig. 1 Intraoperative image showing the absence of gallbladder and hepatic pedicle: The biliary duct is on the right side of the hepatic pedicle as usual.

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  Fig. 2 MRCP image confirms the absence of gallbladder and a normal biliary tree.

Reference

1. Peloponissos N, Gillett M, Cavin R, Halkic N. Agenesis of the gallbladder: a dangerously misdiagnosed malformation. World J Gastroenterol. 2005; 11:6228–6231.

2. Blechschmidt CM. Agenesis of the gallbladder-borderline case of normality? Anat Anz. 1982; 151:281–285.

3. Turkle SB, Swanson V, Chandrasoma P. Malformations associated with congenital absence of the gallbladder. J Med Genet. 1983; 20:445–449.

4. Joliat GR, Shubert CR, Farley DR. Isolated Congenital agenesis of the gallbladder and cystic duct: report of a case. J Surg Educ. 2013; 70:117–120.

5. Bennion RS, Thompson JE Jr, Tompkins RK. Agenesis of the gallbladder without extrahepatic biliary atresia. Arch Surg. 1988; 123:1257–1260.

6. Tang LM, Wang XF, Ren PT, Xu GG, Wang CS. The diagnosis of gallbladder agenesis: two cases report. Int J Clin Exp Med. 2015; 8:3010–3016.

7. Gotohda N, Itano S, Horiki S, Endo A, Nakao A, Terada N, et al. Gallbladder agenesis with no other biliary tract abnormality: report of a case and review of the literature. J Hepatobiliary Pancreat Surg. 2000; 7:327–330.

8. Sherson ND. The absent adult gallbladder. Aust N Z J Surg. 1970; 39:255–258.

9. Toouli J, Geenen JE, Hogan WJ, Dodds WH, Arndorfer RC. Sphincter of oddi motor activity: a comparison between patients with common bile duct stones and controls. Gastroenterology. 1982; 82:111–117.

10. Crade M, Taylor KJ, Rosenfield AT, de Graaff CS, Minihan P. Surgical and pathologic correlation of cholecystosonography and cholecystography. AJR Am J Roentgenol. 1978; 131:227–229.

11. Serour F, Klin B, Strauss S, Vinograd I. False-positive ultrasonography in agenesis of the gallbladder: a pitfall in the laparoscopic cholecystectomy approach. Surg Laparosc Endosc. 1993; 3:144–146.

12. Jackson RJ, McClellan D. Agenesis of the gallbladder: a cause of false-positive ultrasonography. Am Surg. 1989; 55:36–40.

13. Kabiri H, Domingo OH, Tzarnas CD. Agenesis of the gallbladder. Curr Surg. 2006; 63:104–106.

14. Mittal AK, Saxena D, Kadam R, Garg P, Kankaria J, Jenaw R. Agenesis of gallbladder: a diagnostic dilemma. Int J Case Rep Images. 2015; 6:296–300.

15. Cabajo CM, Martin del Olmo JC, Blanco AJ, Atienza SR. Gallbladder and cystic duct absence: an infrequent malformation in laparoscopic surgery. Surg Endosc. 1997; 11:483–484.

16. Fiaschetti V, Calabrese G, Viarani S, Bazzocchi G, Simonetti G. Gallbladder agenesis and cystic duct absence in an adult patient diagnosed by magnetic resonance cholangiography: report of a case and review of the literature. Case Rep Med. 2009; 2009:674768.

17. Malde S. Gallbladder agenesis diagnosed intra-operatively: a case report. J Med Case Rep. 2010; 4:285.

18. Pierro A, Martucci M, Maselli G, Farchione A. Agenesis of the gallbladder with the presence of a small dysmorphic cyst: role of magnetic resonance cholangiopancreatography. J Clin Imaging Sci. 2012; 2:17.

19. Gad MA, Krishnamurthy GT, Glowniak JV. Identification and differentiation of congenital gallbladder abnormality by quantitative technetium-99m IDA cholescintigraphy. J Nucl Med. 1992; 33:431–434.

20. Calder N, Carneiro HA, Khwaja HA, Thompson JN. Gallbladder agenesis with midgut malrotation. BMJ Case Rep. 2012; 2012:bcr1020115053.